Preventing alcohol-related harm presents a range of challenges including those related to political will, competing interests with disproportionate resources, and embedded drinking cultures. On the other hand there are opportunities for health promotion, including clear evidence on both the extent of the problem and evidence-based responses and growing community support for action. Australian researchers continue to contribute substantially to the international evidence base on alcohol, generating evidence for translation into effective programs and producing policy-relevant research on which action and advocacy can be based. Successes in other public health areas also provide useful models for public health approaches to alcohol. Those engaged in health promotion have often been required to do a lot with a little, including communicating health messages on a range of themes, countering industry activities that are contrary to good public health and involvement in policy development. Coalition approaches to alcohol related harm, including links with groups outside health, have recently gained momentum and show much potential. Alcohol issues are now firmly on the agenda of the public and decision-makers, and the alcohol industry has expressed clear concern at current levels of activity. This paper will consider briefly the nature of the challenge; evidence-based approaches; achievements and developments thus far; challenges and obstacles; and the role of health promotion and the health promotion workforce.